Western Aphasia Battery (WAB)

Evidence Reviewed as of before: 07-06-2013
Author(s): Vanessa Barfod, BA
Editor(s): Annabel McDermott, OT., Nicol Korner-Bitensky, PhD OT.
Content consistency: Gabriel Plumier

Purpose

The Western Aphasia Battery (WAB) is a diagnostic tool used to assess the linguistic skills and main nonlinguistic skills of adults with aphasia. This provides information for the diagnosis of the type of aphasia and identifies the location of the lesion causing aphasia.

In-Depth Review

Purpose of the measure

The Western Aphasia Battery (WAB) was developed by Kertesz in 1979 based on the original format of the Boston Diagnostic Aphasia Examination (Goodglass & Kaplan, 1972). It was designed as an assessment tool to examine linguistic skills (information content, fluency, auditory comprehension, repetition, naming and word finding, reading, and writing) and main nonlinguistic skills (drawing, block design, calculation, and praxis) of adults with aphasia. The observed language behaviours facilitate diagnosis by classifying the patient as having 1 of 8 types of aphasia (Global, Broca’s, Transcortical motor, Wernicke’s, Transcortical sensory, Mixed transcortical, Conduction, and Anomic) according to primary aspects of language functioning (Risser & Spreen, 1985). The WAB is also used to determine the location of the lesion.

The WAB is one of the most commonly used assessment tools by speech language pathologists in Canada (Korner-Bitensky et al., 2006).

Available versions

The WAB was originally developed by Kertesz in 1979. It was revised in 1982 and then again in 2006, when it was published as the Western Aphasia Battery-Revised (WAB-R). The WAB-R has a number of improvements including supplemental tasks, revision of the items, more modern equipment (e.g. spiral-bound stimulus book replacing loose stimulus cards), as well as revised directions and scoring guidelines for clarity. The WAB-R also includes a bedside screening tool.

Features of the measure

Subscales:

The WAB is comprised of 8 subscales, the WAB-R includes an additional subscale:

  1. Spontaneous speech
  2. Auditory verbal comprehension
  3. Repetition
  4. Naming and word finding
  5. Reading
  6. Writing
  7. Apraxia
  8. Contructional, visuospatial, and calculation tasks
  9. Supplemental writing and reading tasks (WAB-R only)

Items and scoring:

The WAB consists of two parts:

PART 1
Subtest 1. Spontaneous speech
Task Description Scoring
1. Conversational question: The client verbally responds to 6 personal questions. There are 2 scoring sections for Spontaneous speech: Information content and Fluency, grammatical competence, and paraphasias.For Information content:10 points are given if all 6 questions were answered correctly with sentences of normal length and complexity, as well as a reasonably complete description of the picture. Nine points are given if all 6 questions were answered correctly, as well as an almost complete description of the picture. Eight points are given if 5 questions were answered correctly, with an incomplete description of the picture. Seven points are given if 4 questions were answered correctly, as well as at least 6 items in the picture being mentioned. Six points are given if 4 questions were answered correctly, as well as some response to the picture. Five points are given if 3 questions were answered correctly, as well as some response to the picture. Four points are given if 3 questions were answered correctly. Three points are given if 2 questions were answered correctly. Two points are given if 1 question is answered correctly. One point is given for incomplete responses. No points are given for no information.

For Fluency, grammatical competence, and paraphasias:

Scoring is from 0 to 10. Ten points are given for sentences of normal length and complexity, without slowing down, stopping, or articulatory difficulty, and no paraphasias. As sentences become less lengthy and complex, more slow, and with paraphasias, less points are given.

Please see the test manual for further information.

2. Personal description: The client describes a picture in the stimulus book.
Subtest 2. Auditory verbal comprehension
Task Description Scoring
1. Yes/No questions: The client must answer personal, environment and general questions with a Yes or No. If the client corrects themselves, the last answer is scored. Three points are given for each correct answer. If the answer is ambiguous, 0 points are given. The examiner also marks whether the response was verbal, gestural, or eye blink.
2. Auditory word recognition: The client is shown 6 real objects, as well as cards of pictured objects, forms, letters, numbers and colors. The client must point to what the examiner says. There are 6 items in each category: real objects, drawn objects, forms, letters, numbers, colors, furniture, body parts, fingers and right-left body parts. One point is given to each item pointed to correctly. For the right-left category, the client must get both the side and the body part correct to receive the point. Maximum score is 60.
3. Sequential commands: The client must execute 11 commands that increase in difficulty and length. There are scores associated to the segments in each of the listed commands. Points are given for each correct execution. Please see the test booklet for further information. Maximum score is 80.
Subtest 3. Repetition
Description Scoring
1. The client must repeat words, phrases and sentences of increasing difficulty (from single words to a complex sentence), with a total of 15 items. As length and difficulty increases, more points are given to the client for correct repetition. Two points are given if an item is incompletely repeated. One point is taken off for errors in the sequence of words, or for every literal paraphasia. Maximum score is 100.Scoring takes phonemic errors into account by permitting partial credit.
Subtest 4. Naming and word finding
Task Description Scoring
1. Object naming: Show 20 objects from various categories to client, and ask them to name them one at a time. If there is no response to the visual stimulus, the examiner allows the client to touch the stimulus. If there still isn’t a correct response, the examiner presents a phonemic or semantic cue. A maximum of 20 seconds if given to the client to respond. Three points are given if named correctly (or with a minor articulatory error); 2 points are given for a recognizable phonemic paraphasia; 1 point is given if the client needed a tactile or phonemic cue to respond correctly. Maximum score is 60.Permits sequential tactile and phonemic cueing for the patient who cannot provide the proper name upon initial confrontation with the object, yielding qualitatively useful information without sacrificing the integrity of the scoring system.
2. Word fluency: The client must name as many animals as they can in one minute. One point is given for each animal names, even if it is distorted by literal paraphasia. Maximum score is 20.
3. Sentence completion: The client must complete sentences read to them. Two points are given for correct responses; 1 point is given for phonemic paraphasias. Reasonable alternatives are accepted. Maximum score is 10.
4. Responsive speech: The client must answer 5 sentences read to them. Two points are given for acceptable responses; 1 point is given for phonemic paraphasias. Maximum score is 10.
PART 2
Subtest 1: Reading
Task Description Scoring
1. Reading comprehension of sentences: The client is shown 8 test sentences and asked to point to the best missing word from a list, to complete the sentence. As the sentences increase in length and difficulty, more points are given to the client for correct answers. Maximum score is 40.
2. Reading commands: The client is asked to read a command out loud and then do what it says. There are 6 items. For the first three items, 1 point is given for correctly reading it out loud and 1 point is given for correctly performing the command. For the next/last 3 items, 2 points are given for correctly reading it out loud and 2 points are given for correctly performing the command. A partial score is given if only part of the command is read, or contains paraphasias, or if only part of the command is performed.Maximum score is 20.
At this point, if the combined score of tasks 1 and 2 is 50 or more, give full credit of 100 minus twice the difference of the client’s score from 60
[Score = 100 – 2(60 – Patient’s score].
If this is not the case, continue testing.
3. Written word stimulus-object choice matching: Objects are placed in a random order in front of the client. They are then asked to point to the object that matches the word on the card shown to them. One point is given for every correct response. Maximum score is 6.
4. Written word stimulus-picture choice matching: A card with pictures on it is shown to the client. They are then asked to point to the picture that matches the words on the same card as the previous task. One point is given for every correct response. Maximum score is 6.
5. Picture stimulus-written word choice matching: The same words on the card from the previous two tasks are shown to the client. They are then asked to point to the word that matches the picture that is presented to them one at a time. One point is given for every correct response. Maximum score is 6.
6. Spoken word-written word choice matching: The examiner will say a word and the client must point to one of 5 words written on the card, that matches it. One point is given for every correct response. Maximum score is 4.
7. Letter discrimination: The examiner must take the score from the Auditory word recognition from the second subtest of Part 1 of the WAB. If that score is less than 3, the examiner must show the client cutout letters and have them point to ones that are on the card presented to them. If the score from the Auditory word recognition is less than 3, one point is given for every correct response. Maximum score is 6.
8. Spelled word recognition: The client must say the word that the examiner spells out orally. One point is given for every correct response. Maximum score is 6.
9. Spelling: The client must spell the word said orally to them by the examiner. One point is given for every correct response. Maximum score is 6.
Subtest 2: Writing
Task Description Scoring
1. Writing on request: The client must write down their name and address. One point is given for every recognizable word or number. Half a point is deducted for every spelling mistake or paraphasic error. Maximum score is 6.
2. Written output: The client is given 3 minutes to write a story about a picture they are shown. Thirty-four points are given for a full description; 8 points are given for every complete sentences with at least 6 words; 1 point is given for every correct word in incomplete or short sentences (with a maximum of 10 points for this). Half a point is deducted for every spelling mistake or paraphasic error. Punctuation is not score. Maximum score is 34.
3. Writing to dictation: The client must write down sentences dictated by the examiner. Ten points are given for the complete sentence being written down; 1 point is given for every correct word; 0.5 point is deducted for every spelling mistake or paraphasic error.
At this point, if the combined score of tasks 1, 2 and 3 is 40 or more,
the score is: 2 x patient’s score.
4. Writing of dictated or visually presented words: The client must write down words that were dictated by the examiner. There are 6 items. If the client does not understand the word dictated, the examiner shows them the real object. Full credit is given at this point. If they still don’t understand, the examiner spells the word orally. If the patient still doesn’t know, the examiner provides cut-out letters with 2 extra ones. Half the score is given to correct answers at this point. Half a point is deducted for incorrect letters. Maximum score is 10.
5. Alphabet and numbers: The client must write down the alphabet, as well as numbers 0-20. Half a point is given for every letter or number, despite the order. Maximum score for the alphabet is 12.5; for the numbers is 10.
6. Dictated letters and numbers: The client must write down letters, followed by numbers, dictated by the examiner. Half a point is given for every letter written correctly; 1 point is given for every complete number. Maximum score for the letters is 2.5; for the numbers is 5.
7. Copying a sentence: The client is shown a card with a sentence written on it. They are instructed to copy down this sentence. Ten points are given for the complete sentence; 1 point is given for every correct word; 0.5 point is deducted for every incorrect letter. Maximum score is 10.
Subtest 3: Apraxia
Description Scoring
1. Clients are asked to perform 20 actions. Three points are given for a good performance; 2 points are given for an approximate performance. If the client fails to perform the command well, the examiner imitates the action; 2 points are given for a good performance at this point; 1 point is given for an approximate performance at this point. If the client fails to perform well after imitation, the examiner gives the client the real object, where applicable; 2 points are given if the client uses a body part for an object; 1 point is given for a good performance with the real object. Maximum score is 60.
Subtest 4: Constructional, visuospatial and calculation tasks
Task Description Scoring
1. Drawing: The client must draw 8 figures of different complexity.
2. Block design: The client must arrange 4 blocks to match the picture shown to them from the Stimulus book. There are 3 different pictures that must be matched. The examiner firstly shows the client how to arrange the blocks, then mixes them to allow the client to complete the task. If the client completes the task in 60 seconds, they are given 3 points. If the client fails to complete it in 90 seconds, the examiner mixes the blocks and lets them try again. If they complete it within the extra time (2 minutes) they are given 2 points. They are given 1 point for putting the blocks together.
3. Calculation: The client must solve 12 mathematical equations (addition, subtraction, division, multiplication) by either pointing to or saying one of the 4 answers shown to them on the card. Two points are given for each correct answer. No partial marks are given. Maximum score is 24.
4. Raven’s colored progressive matrices: The client must point to the piece of a pattern from that of a larger pattern. One point is given for each correct answer. One additional point is awarded if the task is completed under 5 minutes. Maximum score is 37.
WAB-R Supplemental writing and reading tasks
Task Description Scoring
1. Writing irregular words to dictation The client must write down the 10 words, with irregular spelling, that the examiner dictates to them. Please refer to the manual.
2. Writing non-words to dictation The client must write down 10 nonsense words that are dictated to them by the examiner. Please refer to the manual.
3. Reading irregular words The client must read 10 words, with irregular spelling, from the stimulus book, out loud. Please refer to the manual.
4. Reading non-words (supplemental) The client must read 10 nonsense words out loud. Please refer to the manual.

Composite scores:

In addition to the subscales scores, there are three additional composite scores (note that the following do not include the supplemental subtest of the WAB-R):

1 – Language Quotient (LQ):

This is the newest summary score that encompasses auditory comprehension, oral expression, reading, and writing performance (Shewan, 1986). The first two elements relate to spoken language performance and the latter two elements relate to written language performance. The LQ uses a 60:40 ratio of spoken to written language performance, in light of the fact that people more regularly use spoken language skills.

Computation: The LQ uses the scores from all subtests of the first part of the WAB (Spontaneous speech, Auditory verbal comprehension, Repetition, Naming and word finding) and the first two subtests of the second part of the WAB (Reading, Writing). The LQ score can range from 0 to 100. Each subtest score is a portion of the total score according to their respective maximum scores, as follows:

Subtest Contribution to the LQ Computation
Spontaneous speech 20% maximum score = 20; patient’s score is recorded as-is
Auditory verbal comprehension 20% maximum score = 200; patient’s score is divided by 10 to reach 20%
Repetition 10% maximum score = 100; patient’s score is divided by 10 to reach 10%
Naming and word finding 10% maximum score = 100; patient’s score is divided by 10 to reach 10%
Reading 20% maximum score = 100; patient’s score is divided by 5 to reach 20%
Writing 20% maximum score = 100; patient’s score is divided by 5 to reach 20%

Accordingly, the LQ is calculated as the sum of each subtest revised score.

Cortical Quotient (CQ):

The CQ is a weighted average of all subtest scores. Since the non-language portion is included in this summary score, it is not a sound indicator of language ability and its severity in aphasia. The LQ score can range from 0-100.

Computation: Like the LQ, each subtest’s score is a portion of the total score.

Subtest Contribution to the LQ Computation
Spontaneous speech 20% maximum score = 20; patient’s score is recorded as-is
Auditory verbal comprehension 20% maximum score = 200; patient’s score is divided by 10 to reach 20%
Repetition 10% maximum score = 100; patient’s score is divided by 10 to reach 10%
Naming and word finding 10% maximum score = 100; patient’s score is divided by 10 to reach 10%
Reading 20% maximum score = 100; patient’s score is divided by 5 to reach 20%
Writing 20% maximum score = 100; patient’s score is divided by 5 to reach 20%

3. Aphasia Quotient (AQ):

The AQ is a weighted average of all subtest scores relating to spoken language, measuring language ability. It is a sum of all subtest scores from the first part of the WAB (Spontaneous speech, Auditory verbal comprehension, Repetition, Naming and word finding). The examiner can use the AQ score to classify the client’s aphasia as 1 of 8 types (Kyoung Kang et al, 2010).

AQ Score Severity
0-25 Very severe
26-50 Severe
51-75 Moderate
76+ Mild

Taxonomic Table of the Western Aphasia Battery (Kertesz, 1982)

Criteria for Classification
Fluency Comprehension Repetition Naming
Global 0 – 4 0 – 3.9 0 – 4.9 0 – 6
Broca’s 0 – 4 4 – 10 0 – 7.9 0 – 8
Isolation 0 – 4 0 – 3.9 5 – 10 0 – 6
Transcortical Motor 0 – 4 4 – 10 8 – 10 0 – 8
Wernicke’s 5 – 10 0 – 6.9 0 – 7.9 0 – 9
Transcortical Sensory 5 – 10 0 – 6.9 8 – 10 0 – 9
Conduction 5 – 10 7 – 10 0 – 6.9 0 – 9
Anomic 5 – 10 7 – 10 7 – 10 0 – 9

Note: However, Risser and Spreen (1984) commented that WAB criteria for classification force assignments to types of aphasia based on idealized subtest scores and avoids the term ‘mixed’ aphasia that accounts for a proportion of the aphasic population.

What to consider before beginning:

  • The client should be well rested and should be allowed frequent breaks during the assessment.
  • The examiner may want to video or the testing session to allow for later review of the client’s performance.
  • The examiner must remember to place all pictures and objects within the client’s visual field.
  • The examiner must be aware of the client’s self-corrections and must always record the client’s responses, whether or not it is correct.
  • The examiner may repeat the instructions once, unless otherwise instructed in the manual.
  • The examiner must not let the client know how they are doing on the test and should be aware not to give cues unless instructed to.
  • Before administering the supplemental section of the WAB-R, the examiner must see the client’s performance on the previous Reading and Writing tasks. The examiner may choose to not administer this last section if the client did not perform satisfactorily, because the level of difficulty is increased. The supplemental section is used to distinguish whether a client has semantic and phonological dyslexia. The examiner may also gather information about spelling dyslexia

Time:

Part 1 of the WAB takes approximately 30-45 minutes; Part 2 takes approximately 45-60 minutes to administer.

The WAB-R includes a Bedside Screener that takes about 15 minutes to administer.

Training requirements:

None typically reported.

Equipment:

The WAB requires specialized equipment, in addition to unlined paper, a pen and pencil, and a stopwatch. The complete set includes 25 record forms, 57 stimulus cards and a test manual. Stimulus cards include a range of images, words and sentences that are shown to the client during the assessment.

The WAB-R contains a pack of 25 bedside record forms, a Raven’s Coloured Progressive Matrices test booklet and manipulative set (cup, comb, flower, matches, screwdriver, 4 Koh’s blocks, watch, hammer, telephone, ball, knife, safety pin, toothbrush, eraser, padlock, key, paperclip, rubber band, spoon, tape, fork).

Detailed administration guidelines are provided in the test manual.

Alternative forms of the Assessment

There are no alternate forms, although there is a bedside screener in the WAB-R in case of time constraints. This bedside screener can be administered in a comfortable setting. The record form provides administration and scoring guidelines. The score retrieved can determine a client’s abilities and functioning before surgery or any other medical procedure.

Can be used with:

  • Patients between the ages of 18 and 89 with acquired neurological disorders due to stroke, a head injury, or dementia.
  • Alzheimer’s disease (Risser & Spreen, 1984)
  • Nonaphasic right hemisphere lesions (Risser & Spreen, 1984)

In what languages is the measure available?

  • Published in English (Risser & Spreen, 1984).
  • Published in Japanese (WAB Aphasia Test Construction Committee, 1986).
  • Available in Hungarian, French, Portuguese, and two Indian language translations (Risser & Spreen, 1984); translated into Turkish (Keklikoglu, Selcuki & Keskin, 2009), translated into Korean (Kim and Na, 2004) (Unpublished).
  • Standardized Cantonese version (CAB; Yiu, 1992).
  • Hebrew version (Kasher, Batori, Soroker, Graves & Zaidel, 1999).

Summary

What does the tool measure? The WAB assesses the linguistic and main nonlinguistic skills of adults with aphasia. This provides information regarding the type and severity of aphasia and lesion location.
What types of clients can the tool be used for? Clients between the ages of 18 and 89 with acquired neurological disorders due to stroke, head injury, or dementia.
Is this a screening or assessment tool? Assessment tool (The WAB-R has a bedside screening tool).
Time to administer
  • 30-45 minutes (Part 1)
  • 45-60 minutes (Part 2)
  • 15 minutes (Bedside Screener)
Versions
  • Cantonese version of the WAB (CAB)
  • Korean version of the WAB (K-WAB)
Other Languages
  • Published in English (Risser & Spreen, 1984) and Japanese (WAB Aphasia Test Construction Committee, 1986).
  • Available in Hungarian, French, Portuguese, and two Indian language translations (Risser & Spreen, 1984); translated into Turkish (Keklikoglu, Selcuki & Keskin, 2009), translated into Korean (Kim and Na, 2004) (Unpublished).
Measurement Properties
Reliability

Internal consistency:

  • One study reported excellent internal consistency of the WAB-LQ.
  • One study reported adequate to excellent internal consistency of the K-WAB Naming subtest.

Inter-rater reliability:

  • One study reported excellent inter-rater reliability of the WAB.
  • One study reported excellent inter-rater reliability of the K-WAB.

Intra-rater reliability:

  • One study reported excellent intra-rater reliability of the WAB.

Test-retest reliability:

  • Three studies reported adequate to excellent test-retest reliability of the WAB.
  • One study reported excellent test-retest reliability of the K-WAB.
  • One study reported excellent test-retest reliability of the WAB.
Validity

Content:

  • Content validity of the WAB was derived from comparison with content of other aphasia test batteries.

Construct:

  • One study examined construct validity of the WAB by factor analysis.

Convergent/Discriminant Validity:

  • Six studies examined convergent validity of the WAB and have reported excellent correlations with the Neurosensory Center Comprehensive Examination for Aphasia and the Mississippi Aphasia Screening Test; adequate to excellent correlations with the Communicative Effectiveness Index; and adequate correlations with tests of word productivity and error frequency during fluent speech.
  • One study examined convergent validity of the WAB and reported adequate to excellent correlations with Main Concept analysis
  • Two studies examined discriminant validity of the WAB and reported adequate correlations with the Raven’s Coloured Progressive Matrices; excellent correlations with the Scandinavian Stroke Scale; and adequate correlations with the Functional Independence Measure and Barthel Index.

Known Group Validity:

  • 4 studies examined known group validity of the WAB and determined that the tool is able to differentiate between individuals with aphasia and individuals without aphasia; different types of aphasia (except Broca’s and Wernicke’s aphasia); and different severity of aphasia.

Criterion:

Predictive Validity:

  • No studies have examined predictive validity of the WAB with patients with stroke.

Concurrent Validity:

  • One study examined concurrent validity of the K-WAB and reported adequate to excellent correlations with the Korean version of the Boston Naming Test.
Floor/Ceiling Effects No studies have examined floor/ceiling effects of the WAB in clients with stroke.
Sensitivity/Specificity Two studies have reported on sensitivity/specificity of the WAB with patients with stroke. The authors of the measure recommended a cut-off score of 93.8 to determine ‘aphasic’ performance on the WAB Aphasia Quotient, with 60% sensitivity and 100% specificity. A corresponding WAB Cognitive Quotient cutoff score of 95.32 resulted in 80% sensitivity and specificity.
Does the tool detect change in patients? The WAB has been used to detect change in communication or severity of aphasia over time or in response to intervention.
Acceptability The WAB is quite lengthy to administer.
Feasibility No specific training is required to administer the WAB.
How to obtain the tool? Available at Pearson assessments

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the WAB relevant to individuals with stroke. Thirteen studies were found.

Floor/Ceiling Effects

No studies have reported on floor or ceiling effects of the WAB specific to clients with stroke.

Reliability

Internal Consistency:

Shewan and Kertesz (1980) examined internal consistency of WAB Spontaneous Speech, Auditory Comprehension, Repetition, Naming, Reading and Writing subtests (reported by Shewan (1986) as the WAB-LQ) with 140 patients with aphasia secondary to acute stroke, using Cronbach’s alpha and Bentler’s coefficient theta. Internal consistency of all subtests was excellent (a=0.905; q=0.974).

Kim and Na (2004) used the Korean Western Aphasia Battery (K-WAB) to examine the relationships between the Naming subtest total score and tasks: Object Naming (ON), Word Fluency (WF), Sentence Completion (SC) and Responsive Speech (RS). There were excellent correlations between the Naming subtest total score and all tasks (ON: r=0.971; WF: r=0.693; SC: r=0.785; RS: r=0.797). There were excellent correlations between all tasks (r=0.606-0.726) except for an adequate correlation between the SC and WF tasks (r=0.534). These correlations suggest that all tasks are similar enough to be part of the same subtest, but not too similar to be redundant.

Inter-rater reliability:

Shewan and Kertesz (1980) examined inter-rater reliability of the WAB administered to 10 patients with aphasia secondary to stroke several months apart, using Pearson product moment correlation coefficients. Videotapes were independently scored by 8 judges and correlations were averaged for each subtest. Inter-rater reliability was excellent for the WAB-AQ, WAB-CQ, WAB-LQ subtests (also reported in Shewan, 1986) and the Praxis and Construction subtests.

Kim and Na (2004) examined inter-rater reliability of the K-WAB in a sample of patients, where 93.7% presented with acute or subacute stroke, using Pearson’s correlation coefficient. Three certified Speech-Language Pathologists assessed video-recordings of participants’ language performance. Inter-rater reliability was excellent for the K-WAB composite scores and all subtests (Aphasia Quotient: r=1.000; Language Quotient: r=0.997; Cortical Quotient: r=1.000; Spontaneous Speech – Fluency: r=0.994; Spontaneous Speech – Content: r=0.993; Auditory Comprehension: r=1.000; Repetition: r=0.999; Naming: r=0.999; Reading: r=0.999; Writing: r=0.999; Praxis: r=1.000; Construction: r=0.998).

Note: The number of participants used to calculate inter-rater reliability was unclear.

Intra-rater reliability:

Shewan and Kertesz (1980) reported on intra-rater reliability of the WAB administered to 10 patients with aphasia secondary to stroke several months apart. Videotapes were viewed and scored by 3 judges. Intra-rater reliability was excellent for the WAB-AQ (r=0.986-0.997), WAB-CQ (r=0.992-0.998), all WAB-LQ subtests (also reported in Shewan, 1986): Spontaneous Speech – Information Content (r=0.926-944), Spontaneous Speech – Fluency (r=0.794-0.989), Comprehension (r=0.985-0.993), Repetition (r=0.993-0.997), Naming (r=0.995-0.999), Reading/Writing (r=0.985-0.998), and the Praxis (r=0.983-0.989) and Construction (0.948-0.996) subtests.

Test-retest reliability:

Kertesz and McCabe (1977) assessed 1-year test-retest reliability of the WAB in 22 patients with aphasia secondary to chronic stroke, using Pearson r correlation coefficient and reported excellent test-retest reliability (r=0.992).

Shewan and Kertesz (1980) examined test-retest reliability of the WAB in a sample of up to 38 patients with aphasia secondary to chronic stroke, using Pearson correlation coefficients. Participants were assessed on two occasions anywhere from 6 months to 6.5 years apart (average 12-23 months between testing). Test-retest reliability was excellent for the WAB-AQ (r=0.968), WAB-CQ (n=9, r=0.895), WAB-LQ subtests (also reported in Shewan, 1986): Spontaneous Speech – Information Content (r=0.947) and Fluency (r=0.941), Comprehension (r=0.881), Repetition (r=0.970), Naming (r=0.923), Reading (n=32; r=0.927) and Writing (n=25; r=0.956) and the Construction subtest (n=14, r=974). Test-retest reliability was adequate for the Praxis subtest (n=18, r=0.581).

Pederson, Vinter and Skyhoj Olsen (2001) examined 3½-month test-retest reliability of the WAB in a sample of 19 patients with aphasia secondary to chronic stroke, using Pearson correlation coefficient and reported excellent test-retest reliability (r=0.96). There was no significant change in WAB scores across the two time points.

Kim and Na (2004) examined 5-day test-retest reliability of the K-WAB in a sample of 20 neurologically stable aphasic patients, using Pearson’s correlation coefficient. Test-retest reliability of composite scores and all subtests was excellent (Aphasia Quotient: r=0.976; Language Quotient: r=0.977; Cortical Quotient: r=0.920; Spontaneous Speech: r=0.96; Auditory Comprehension: r=0.967; Repetition: r=0.952; Naming: r=0.934; Reading: r=0.986; Writing: r=0.988; Praxis, r=0.908; Construction: r=0.922). These results suggest that all subtests of the K-WAB are stable and reliable over a short time period.

Pak-Hin Kong (2011) examined test-retest reliability of the Cantonese version of the WAB (CAB) in a sample of 16 participants with aphasia secondary to chronic stroke, using Spearman’s rho correlation. Participants were examined on two occasions, 12 to 16 months apart. Test-retest reliability was excellent for the Spontaneous Speech subtest – Information, Fluency and total scores (r=0.83, 0.94, 0.96 respectively) and for the Naming subtest (r=0.91) and overall AQ (r=0.93). Participants did not demonstrate significant differences in CAB scores across the two evaluations.

Validity

Content:

Shewan and Kertesz (1980) reported that the WAB appears to meet subjective criteria for content validity as it measures language content areas common to all aphasia batteries and has similar items to the BDAE.

Shewan (1986) examined content validity of the WAB-LQ by comparison with content of other aphasia test batteries. WAB-LQ subtests (Spontaneous Speech, Auditory Comprehension, Naming, Repetition, Reading, Writing) span the domain of spoken and written language, are aspects typically addressed in rehabilitation, and are also included in common aphasia test batteries in terms of area assessed, content and difficulty.

Construct:

Kertesz and Phipps (1977) examined construct validity of the WAB by factor analysis with a sample of 142 patients with aphasia secondary to stroke, using an r-type Principal Components Analysis. Results indicated that the five subtests contributing to the total AQ load relatively equally on Root 1, which accounts for 83% of total variance. The Fluency and Comprehension subtests were the principal components for Root 2, which accounted for 9% of total variance. Repetition and Information Content were principal components of Root 3, which accounted for 7% of total variance. Naming was the principal component for Root 4, which accounted for 2% of total variance.

Convergent/Discriminant Validity:

Shewan and Kertesz (1980) examined convergent validity of the WAB by comparison with corresponding subtests of the Neurosensory Center Comprehensive Examination for Aphasia (NCCEA) with a sample of 15 patients with aphasia, using Pearson correlation coefficients. Correlations were excellent between: WAB Spontaneous Speech and NCCEA Description of Use and Sentence Construction (r= 0.817); WAB Comprehension and NCCEA Identification by Name and Identification by Sentence (r= 0.915); WAB Repetition and NCCEA Sentence Repetition (r= 0.880); WAB Naming and NCCEA Visual Naming and Word Fluency (r= 0.904); WAB Reading and NCCEA Reading subtests (r=0.919); WAB Writing and NCCEA Writing subtests (r=0.905); and WAB and NCCEA total scores (r=0.973). There was also an excellent correlation between the WAB-CQ (minus the Praxis and Construction subtests) and a comparable NCCEA score (minus the Tactile Naming-Right/Left, Articulation, Digit Repetition-Forward/Backward subtests) (r=0.964).

Shewan and Kertesz (1980) examined discriminant validity of the WAB by comparison with Raven’s Coloured Progressive Matrices scores with a sample of 140 patients with aphasia, using Pearson product-moment correlation coefficients. There was an adequate correlation (r=0.547) between the two tests, indicated that the WAB had some influence of intelligence.

Laures-Gore, DuBay, Duff and Buchanan (2010) examined convergent validity of the WAB AQ by comparison with measures of word productivity (WP) and error frequency (EF) in fluent speech in a sample of 14 patients with aphasia secondary to stroke, using Pearson correlation coefficients. WP was measured as the proportion of productive words to total words for each minute of a language sample, and EF was measured as the total number of errors divided by the total number of productive words across a 10-minute speech sample. There was an adequate positive correlation between WAB AQ and WP (r=0.59) and an adequate negative correlation between WAB AQ and EF (r=-0.54).

Bakheit, Carrington, Griffiths and Searle (2005) examined convergent validity of the WAB by comparison with the Communicative Effectiveness Index (CETI) in 67 patients with aphasia and acute stroke, using Pearson correlation coefficients. Participants received multidisciplinary rehabilitation including conventional speech language pathology began on admission to a rehabilitation unit and continued on discharge from hospital. Measures were taken at baseline, 4 weeks, 8 weeks, 12 weeks and 24 weeks. There was an excellent correlation between the two assessments over all test periods (r=0.71), with adequate to excellent correlations at each time point (r= 0.70, 0.67, 0.53, 0.66 and 0.68, respectively).

Pederson, Vinter and Skyhoj Olsen (2001) examined convergent validity of the WAB by comparison with a Danish adaptation and translation of the Communicative Effectiveness Index (CETI) in 66 patients with aphasia secondary to chronic stroke, using Pearson correlation coefficients. There was an excellent correlation between the CETI and the WAB Aphasia Quotient (r=0.76). There were adequate to excellent correlations between the CETI and WAB Information (r=0.73), Fluency (r=0.73), Comprehension (r=0.65), Repetition (r=0.53) and Naming (r=0.75) subtests. There were adequate to excellent correlations between the CETI and WAB reading (r=0.70), writing (r=0.69), apraxia (r=0.60), calculation (r=0.64), block design (r=0.34), drawing (r=0.41) and Raven Coloured Matrices (r=0.41) tasks.

Pederson, Vinter and Skyhoj Olsen (2001) examined discriminant validity of the WAB Aphasia Quotient (WAB-AQ) and Raven Coloured Matrices by comparison with the Scandinavian Stroke Scale (SSS), Barthel Index (BI) and Frenchay Activities Index (FAI) with a sample of 66 patients with aphasia secondary to chronic stroke, using Pearson Correlation. There was an excellent correlation between the WAB-AQ and the SSS (r=0.64) and adequate correlations between the WAB-AQ and the BI (r=0.44) and the FAI (r=0.50). There were adequate correlations between the WAB Raven Coloured Matrices and the BI (r=0.41) and FAI (r=0.48).

Kostalova et al. (2008) examined convergent validity of the WAB by comparison with the Czech version of the Mississippi Aphasia Screening Test (MASTcz) in 45 patients with left hemisphere strokes with aphasia, using Pearson product-limit correlation. There was an excellent correlation between the two tests (r= 0.933).

Ivanova and Hallowell (2012) examined convergent validity of the WAB-R Spontaneous speech, Auditory verbal comprehension, Repetition and Naming subtests and Aphasia Quotient with an Eye Movement Working Memory (EMWM) task in a sample of 28 people with aphasia secondary to stroke. There were no significant correlations between tests following Holm correction to control for familywise alpha.

Pak-Hin Kong (2011) examined convergent validity of the Cantonese version of the WAB (CAB) with the main concept (MC) analysis in 16 participants with aphasia secondary to chronic stroke, using Spearman’s rho coefficients. MC analysis captures the presence, accuracy, completeness and efficiency of content in oral narratives among Cantonese speakers with aphasia, and scores included: number of accurate and complete concepts (AC); number of accurate but incomplete concepts (AI), number of inaccurate concepts (IN), number of absent concepts (AB), MC score (MC) and number of accurate and complete concepts per min (AC/min). Scores were correlated with the CAB Spontaneous Speech subtest Information, Fluency and total scores, Naming subtest and overall AQ. Participants were examined on two occasions, 12 to 16 months apart. At both time points there were adequate to excellent correlations between the CAB Spontaneous Speech Information score and most related MC measures (AC: r=0.54, 0.73; AI: r=0.60, 0.62; AB: r=-0.64, -0.75; MC score: r=0.64, 0.76), and excellent correlations between the CAB Spontaneous Speech Fluency score and most related MC measures (AC: r=0.94, 0.93; AB: r=-0.91, -0.87; MC score: r=0.94, 0.91; AC/min: r=0.94, 0.93), CAB Spontaneous Speech score and MC score (r=0.96, 0.90), CAB Naming subtest and related MC measures (AC: r=0.91, 0.89; AB: r=-0.85, -0.84; MC score: r=0.89, 0.92) and CAB overall AQ and related MC measures (AC: r=0.91, 0.89; AB: r=-0.93, -0.84; MC score: r=0.95, 0.91).

Known group validity:

Shewan and Kertesz (1980) examined known-group validity of the WAB with a sample of 117 patients with aphasia and 122 control subjects without aphasia, using Newman-Keuls Shortest Significant Range Test. Patients with aphasia were categorized according to type: anomic aphasia (n=37), conduction aphasia (n=13), Wernicke’s aphasia (n=18), Broca’s aphasia (n=25) or global type aphasia (n=24). Control subjects without aphasia formed one of three groups: non-brain injured adults (n=31), individuals with non-dominant-hemisphere lesions (n=70) or individuals with diffuse brain lesions (n=21). Results indicated that the control groups differed significantly from all aphasic types, excluding the anomic group. The control groups did not differ significantly among themselves. All aphasic groups differed significantly among themselves, with the exception of the Broca’s and Wernicke’s aphasic types. The global aphasic group scored significantly lower than other aphasic groups.

Shewan (1986) examined change in WAB-LQ scores over time in a sample of 50 adults with aphasia secondary to acute stroke. Participants were stratified according to aphasia severity based on baseline WAB-AQ scores (mild, moderate, severe) and were assessed at baseline (2-4 weeks post-onset of aphasia), 3 months, and at least 6 months post-baseline. Post-hoc analysis by Newman-Keuls shortest significant range test revealed significant differences among the three groups from baseline to final assessment (p<0.05). WAB-LQ scores changed in a similar fashion for the three severity levels across time. Greatest gains were seen among patients with moderate or severe aphasia.

Ross and Wertz (2003) examined known-group validity of the WAB with a sample of 18 healthy adults and 18 patients with aphasia secondary to chronic stroke, using Wilcoxon’s rank sum test (W). There were significant differences between groups for WAB aphasia quotient and cortical quotient (p<0.000).

Ross and Wertz (2004) examined known-group validity of the WAB in a sample of 10 healthy (non-brain-injured) adults and 10 patients with mild aphasia secondary to chronic stroke. There were significant differences between groups for the WAB aphasia quotient and cortical quotient (p<0.000).

Criterion:

Predictive:

No studies have reported on predictive validity of the WAB with patients with stroke.

Concurrent validity:

Kim and Na (2004) examined concurrent validity of the K-WAB Naming subtest and the Korean version of the Boston Naming Test (K-BNT) in 238 patients, where 93.7% (n=223) of patients presented with stroke. There were excellent correlations between the K-BNT score and K-WAB Object Naming (r=0.720) and Word Fluency (r=0.613) tasks and Naming subtotal score (r=0.719). There were adequate correlations between the K-BNT score and the K-WAB Sentence Completion (r=0.526) and Responsive Speech (r=0.553) tasks.

Sensitivity/Specificity:

Ross and Wertz (2004) examined sensitivity and specificity of the WAB with a sample of 10 patients with mild aphasia secondary to chronic stroke and 10 healthy (non-brain-injured) adults. A prescribed score of 93.8 was used to determine ‘aphasic’ performance on the WAB Aphasia Quotient, with 60% sensitivity and 100% specificity. A corresponding WAB Cognitive Quotient cutoff score of 95.32 resulted in 80% sensitivity and specificity.

Kim and Na (2004) examined sensitivity and specificity of the K-WAB with a sample of 238 patients, where 93.7% (n=223) presented with acute or subacute stroke. Patients were grouped according to age (15-74 years vs. ≥75 years) and years of education (0, 1-6, ≥7). The following results were found for the AQ:

  • For patients between 15-74 years with 0 years of education an optimal cutoff score of 85.25 resulted in 93% diagnostic accuracy, 92% sensitivity and 94% specificity (area under the curve (AUC) = 0.973);
  • For patients between 15-74 years with 1-6 years of education an optimal cutoff score of 87.45 resulted in 96% diagnostic accuracy, 94% sensitivity and 100% specificity (AUC = 0.998);
  • For patients between 15-74 years with over 7 years of education an optimal cutoff score of 93.25 resulted in 94% diagnostic accuracy, 93% sensitivity and 96% specificity (AUC=0.986);
  • For patients 75 years and older with 0 years of education an optimal cutoff score of 74.05 resulted in 94% diagnostic accuracy, 100% sensitivity and 94% specificity (AUC=0.976);
  • For patients 75 years and older with 1-6 years of education an optimal cutoff score of 86.00 resulted in 100% diagnostic accuracy, sensitivity and specificity (AUC=1.000);
  • For patients 75 years of age and older with over 7 years of education an optimal cutoff score of 88.30 resulted in 93% diagnostic accuracy, 94% sensitivity and 90% specificity (AUC=0.975).

The following results were found for the LQ:

  • For patients between 15-74 years with 1-6 years of education an optimal cutoff score of 79.96 produced 96% diagnostic accuracy, 94% sensitivity and 100% specificity (AUC=0.982);
  • For patients between 15-74 years with over 7 years of education an optimal cutoff score of 89.05 produced 94% diagnostic accuracy, 96% sensitivity and 93% specificity (AUC=0.977);
  • For patients 75 years and older with 1-6 years of education an optimal cutoff of 65.9 produced 100% diagnostic accuracy, sensitivity and specificity (AUC=1.000);
  • For patients 75 years and older with over 7 years of education an optimal cutoff of 72.7 produced 100% diagnostic accuracy, sensitivity and specificity (AUC=1.000).

The following results were found for the CQ:

  • For patients between 15-74 years with 1-6 years of education the optimal cutoff score of 77.65 produced 100% diagnostic accuracy, sensitivity and specificity (AUC=1.000);
  • For patients between 15-74 years of age, with over 7 years of education the optimal cutoff score of 90.85 produced 95% diagnostic accuracy, 94% sensitivity and 96% specificity (AUC=0.986);
  • For patients 75 years and older with 1-6 years of education the optimal cutoff score of 69.72 produced 100% diagnostic accuracy, sensitivity and specificity (AUC=1.000);

For patients 75 years and older with over 7 years of education the optimal cutoff score of 75.86 produced 100% diagnostic accuracy, sensitivity and specificity (AUC=1.000).

Responsiveness

Shewan (1986) examined change in WAB-LQ scores over time in a sample of 50 adults with aphasia secondary to acute stroke, who received treatment (n=42) or no treatment (n=8). Participants were assessed at baseline (2-4 weeks post-onset of aphasia), 3 months, and at least 6 months post-baseline. There was a significant main effect for time (F=43.33, df=2.96, p<0.0001), and post-hoc analysis by Newman-Keuls shortest significant range test revealed significant differences in the mean scores for the three tests (p<0.01). These significant increases in WAB-LQ scores with recovery support its validity as a measure of severity.

Aftonomos, Steele, Appelbaum and Harris (2001) used the WAB to measure change in communication at the impairment level following a community-based Language Care Center (LCC) Treatment Program with a sample of 50 patients with aphasia, 49 secondary to subacute or chronic stroke. Participants’ mean scores improved significantly from pre- to post-treatment on all WAB subtests, with absolute percentages ranging from 6.5% to 13% improvement (p values ranging from p<0.01 to p<0.0001). Participants were categorized according to pre-treatment WAB AQ scores: (a) < 25 (n=13); (b) 25-50 (n=16); (c) 50-75 (n=12); and (d) ≥ 75 (n=9). Mean AQ scores improved by +8.8, +11.2, +13.6 and +7.9 (respectively), whereby participants with scores in the two middle groups showed greater gains than those with scores at the extremes.

References

  • Aftonomos, L.B., Steele, R.D., Appelbaum, J.S., & Harris, V.M. (2001). Relationships between impairment-level assessments and functional-level assessments in aphasia: Findings from LCC treatment programmes. Aphasiology, 15(10/11), 951-964.
  • Bakheit, A.M.O., Carrington, S., Griffiths, S., & Searle, K. (2005). High scores on the Western Aphasia Battery correlate with good functional communication skills (as measured with the Communicative Effectiveness Index) in aphasic stroke patients. Disability & Rehabilitation, 27(6), 287-291.
  • Goldstein, G., Beers, S. R., & Hersen, M. (2004). Comprehensive Handbook of Psychological Assessment: Intellectual and Neuropsychological Assessment. New Jersey: John Wiley & Sons.
  • Goodglass, H. & Kaplan, E. (1972). The Assessment of Aphasia and Related Disorders. Philadelphia: Lea & Febiger.
  • Ivanova, M.V. & Hallowell, B. (2012). Validity of an eye-tracking method to index working memory in people with and without aphasia. Aphasiology, 26(3-4), 556-578.
  • Kertesz, A. & McCabe, P. (1977). Recovery patterns and prognosis in aphasia. Brain, 100, 1-18.
  • Kertesz, A., & Phipps, J. B. (1977). Numerical taxonomy of aphasia. Brain and Language, 4(1), 1-10.
  • Kertesz, A. (1982). Western Aphasia Battery Test Manual. New York: Grune and Stratton.
  • Kim, H., & Na, D.L. (2004). Normative data on the Korean version of the Western Aphasia Battery. Journal of Clinical and Experimental Neuropsychology, 26(8), 1011-1020.
  • Kostalova, M., Bartkova, E., Sajgalikova, K., Dolenska, A., Dusek, L., & Bednarik, J. (2008). A standardization study of the Czech version of the Mississippi Aphasia Screening Test (MASTcz) in stroke patients and control subjects. Brain Injury, 22(10), 793-801.
  • Laures-Gore, J.S., DuBay, M. F., Duff, M. C., & Buchanan, T. W. (2010). Identifying behavioral measures of stress in individuals with aphasia. Journal of Speech, Language, and Hearing Research, 53(5), 1394-1400.
  • Pak-Hin Kong, A. (2011). The main concept analysis in Cantonese aphasic oral discourse: External validation and monitoring chronic aphasia. Journal of Speech, Language, and Hearing Research, 54(1), 148-159.
  • Pedersen, P.M., Vinter, K., & Skyhoj Olsen, T. (2001). The Communicative Effectiveness Index: Psychometric properties of a Danish adaptation. Aphasiology, 15(8), 787-802.
  • Risser, A. H., & Spreen, O. (1985). Test review: The Western Aphasia Battery. Journal of Clinical and Experimental Neuropsychology, 7(4), 463-470.
  • Ross, K. B. & Wertz, R. T. (2003). Discriminative validity of selected measures for differentiating normal from aphasic performance. American Journal of Speech-Language Pathology, 12(3), 312-319.
  • Ross, K.B. & Wertz, R.T. (2004). Accuracy of formal tests for diagnosing mild aphasia: An application of evidence‐based medicine. Aphasiology, 18(4), 337-355.
  • Shewan, C.M. (1986). The language quotient (LQ): A new measure for the Western Aphasia Battery. Journal of Communication Disorders, 19(6), 427-439.
  • Shewan, C.M., & Kertesz, A. (1980). Reliability and validity characteristics of the Western Aphasia Battery (WAB). Journal of Speech and Hearing Disorders, 45(3), 308-324.
  • WAB Aphasia Test Construction Committee (1986). The Japanese version of the Western Aphasia Battery. Tokyo:Igaku-Shoin Ltd.
  • Yiu, E.M.L. (1992) Linguistic assessment of Chinese-speaking aphasics: Development of a Cantonese aphasia battery. Journal of Neurolinguistics, 7, 379-424.

See The Measure

How to obtain the WAB

The WAB-R can be purchased online at Pearson Assessment & Information

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